HealthPayerIntelligence News

Humana and Baptist Health reach contract agreement for in-network coverage

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Kentucky-based Baptist Health Medical Group and Humana have reached a new contract agreement, restoring in-network coverage for Medicare Advantage and commercial patients. The multi-year agreement...

Wellcare partners with tech company to improve value-based primary care

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Wellcare, the Medicare brand of Centene Corporation, has partnered with a technology company to improve access to value-based primary care. The company, Pearl Health, focuses on physician enablement...

Continuous Medicaid eligibility during PHE improved postpartum coverage

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The continuous Medicaid eligibility requirement during the COVID-19 public health emergency was associated with increased postpartum Medicaid enrollment and reduced uninsurance, according to a study...

2024 Medicare Advantage premiums remain low and stable

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The average Medicare Advantage premium has remained low and stable, with many beneficiaries choosing plans with a zero-dollar monthly premium, according to data from eHealth, Inc. eHealth’s...

Medicare Advantage enrollment increased by 1.7 million beneficiaries

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Medicare Advantage enrollment has increased by 1.7 million beneficiaries since 2023, with for-profit health plans dominating the market, a Chartis report revealed. Among 65.9 million Medicare-eligible...

Few Physicians Participate in Both Medicaid and Marketplace Plans

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Less than three in ten primary care physicians participating in Medicaid also participated in an average marketplace network, raising concerns about continuity of care for beneficiaries disenrolled...

Utilization Restrictions on Medicare Part D Drugs Increased, Study Finds

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Utilization restrictions on Medicare Part D drugs, including prior authorization and formulary restrictions, increased over time between 2011 and 2020, according to a Health Affairs study. Pharmacy...

Medicare Advantage Beneficiaries Receive Less Home Healthcare Services

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Medicare Advantage beneficiaries received shorter and less intensive home healthcare services than those in traditional Medicare, a study published in JAMA Health Forum found. The Medicare home...

Health Insurance Costs Are Growing Too Expensive for Small Businesses

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While small businesses know the advantages of providing health insurance, many employers are concerned about the rising costs of health benefits, with most businesses that do not offer health insurance...

MA Payment Reductions May Impact Value of Healthcare for Beneficiaries

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The proposed 2025 Medicare Advantage Advance Notice would impact the value of healthcare for beneficiaries, resulting in higher costs, according to an analysis from the Berkeley Research Group...

UnitedHealth Group Scrutinized for Alleged Antitrust Practices

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The Department of Justice (DOJ) is investigating antitrust allegations against UnitedHealth Group, with a specific focus on the ties between UnitedHealthcare and Optum, according to a Wall Street...

Privately Insured Adults Are Satisfied With Health Plan Coverage

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Privately insured adults are generally satisfied with their health plan coverage, valuing their low out-of-pocket costs and premiums, provider networks, and prescription drug coverage, according to...

Care Access, Coverage Value Similar in Medicare Advantage and Medicare

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Coverage and care experiences were generally similar for Medicare Advantage and traditional Medicare beneficiaries, but instances of care delays and health assessments differed, a survey from the...

CareSource Partnership Boosts Access to Substance Use Disorder Treatment

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CareSource has partnered with CKF Addiction Treatment to improve member access to substance use disorder treatment in Central Kansas. “Our shared commitment to decreasing substance use disorder...

Dental Coverage in Medicare Advantage Plans Varies by Demographic

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Almost a third of beneficiaries had a Medicare Advantage plan that didn’t offer dental coverage in 2019, but coverage was more common among historically underserved populations, a study published...

Elevance Health’s $2.5B Acquisition of BCBSLA Paused a Second Time

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Blue Cross Blue Shield Louisiana (BCBSLA) announced that it will not move forward with plans to be acquired by Elevance Health. “We continue to hear from our stakeholders that they want Blue...

7 Out of 10 Americans Struggling With Medical Debt Owe Over $1,000

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One in twelve adult Americans owe medical debt, largely those who are uninsured, low-income, or disabled, according to a report from the Peterson-KFF Health System Tracker. Research on rampant medical...

HHS Will Provide Technical Assistance to States Addressing Homelessness

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The Department of Health and Human Services (HHS) and the Department of Housing and Urban Development (HUD) are increasing access to federal programs and resources that address homelessness in eight...

Medicare Advantage Intake Surveys May Draw Insights, But Not Always

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New Medicare Advantage plan members can self-report their health literacy status during the enrollment process, but may not be as responsive in an enrollment survey of perceived healthcare...

KLAS Report Reveals Top-Performing Vendors for Payer Services

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Using technology to assist with payer operations can help streamline workflows and relieve administrative burden. The 2024 Best in KLAS Software & Services report highlights the top-performing...